Revision Total Hip ArthroplastyWei-Ming Chen, M.D.*, James P. McAuley, M.D., C. Anderson Engh, Jr., M.D., Robert H. Hopper Jr., Ph.D., Charles A. Engh, M.D.
* Dept. of Orthopaedics and Traumatology, Veterans General Hospital-Taipei and Dept. of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Investigation performed by Anderson Orthopaedic Research Institute, Alexandria, VA
Abstract:Purpose: This study reviewed 45 hips in 44 patients who underwent a revision hip arthroplasty with an extended slide trochanteric osteotomy.
Results: By six months, 84% (37/44) of the osteotomy sites were united. Eighty-four per cent (37/44) of the osteotomy gaps were not visible on the radiographs by 12 months. After an average 44-month follow-up, the union rate of the distal osteotomy site was 98% (44/45) with no change in the femoral component position.
The number of cables and preoperative bone quality were not significantly correlated with the union time of the osteotomy site. The preoperative cancellous-bone quality of the greater trochanter also did not significantly influence the union time of the osteotomy site ( p = 0.76, independent samples t-test). Interestingly, the time of bridging-callus union was significantly longer in the cases with a strut allograft than in those cases without a strut allograft (p = 0.04, independent samples t-test). There were two fractures of the osteotomy fragment. One fracture occurred through the superior edge of the strut allograft and the second fracture was at the level of the first cable. However, both fractured fragments migrated less than one centimeter and no reoperation was needed.
Conclusion: The extended slide trochanteric osteotomy improves acetabular and femoral exposure, facilitates the removal of distal cement or a well-fixed, porous-coated stem, and provides reliable reattachment and healing of the trochanteric fragment. We recommend that this technique be considered for complicated revision hip arthroplasties.
